基底型细胞角蛋白在乳腺导管内增生性病变诊断中的应用  

Application of basal-type cytokeratins in intraductal proliferative lesions of the breast

作　　者：郎志强[1] 魏兵[1] 步宏[1] 张红英[1] 李新军[1] 陈卉娇[1] 

机构地区：[1]四川大学华西医院病理科,成都610041

出　　处：《临床与实验病理学杂志》2006年第1期19-23,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的比较不同类型基底型细胞角蛋白(CK5、CK34βE12和CK14)在乳腺导管内增生性病变中的辅助诊断价值,并结合肌上皮标记、超微电镜对普通型导管增生的细胞成分进行初步分析。方法参照2003年WHO乳腺疾病分类的诊断标准筛选出28例导管普通型增生(UDH)、10例不典型增生(ADH)和25例导管原位癌(DCIS)。所有病例均进行CK5/6、CK34βE12、CK14、CK8、浕SMA、calponin和p63的免疫组化染色。4例UDH和1例DCIS通过电镜观察其增生细胞的超微结构。结果CK5/6在UDH、ADH和DCIS增生细胞中的阳性表达率分别为92.9%、10.0%和0。CK34βE12和CK14的阳性表达率分别为96.4%和82.1%(UDH)、20.0%和30.0%(ADH)、24.0%和28.0%(DCIS)。所有UDH的增生细胞均不表达浕SMA、calponin和p63。电镜观察显示UDH和DCIS的增生细胞中未发现符合肌上皮超微特征的细胞存在。结论基底型CK有助于UDH和ADH/DCIS的鉴别诊断,其中CK5/6较CK34βE12和CK14特异性更高。免疫组化染色和电镜观察结果支持UDH的增生细胞含有多种成分,包括定向干细胞、腺中间细胞和腺终端细胞等,但未发现具有肌上皮特点的细胞参与其中。Purpose This study was performed to compare the diagnostic value of basal-type cytokeratins （CK5/6, CK34βE12 and CK14） in breast intraductal proliferative lesions and evaluate the hyperplasia cells in usual ductal hyperplasia by additional myoepithelial markers and electron microscopy. Methods 28 usual ductal hyperplasia （ UDH）, 10 atypical ductal hyperplasia （ADH） and 25 ductal carcinoma in situ （DCIS） were selected according to World Health Organization of tumors： Pathology ＆ genetics tumors of breast （2003）. The immunostaining of CK5/6, CK34βE12, CK14, CK8, α-SMA, calponin and p63 was detected in all cases. 4 UDH and 1 DCIS samples were observed to research the ultrastructure of hyperplasia cells by electron microscopy. Results The positive expression rate of CK5/6 in hyperplasia cells of UDH, ADH and DCIS was 92.9% , 10.0% and 0 respectively. The positive expression rate of CK34βE12 and CK14 was 96.4% and 82. 1% in UDH, 20. 0% and 30.0% in ADH, 24. 0% and 28. 0% in DCIS respectively. There was no α-SMA, calponin and p63 staning in the hyperplasia cells of UDH. No cells which have the characteristic of myoepithelial cells was observed in hyperplasia cells of UDH and DCIS by electron microscopy. Conclusions Basal-type CKs are useful to differential diagnosis of breast intraductal proliferative lesions （UDH and ADH/DCIS）. CK5/6 immunostaning appears to be more specific than CK34βE12 and CK14. The results by immunohistochemistry and electron microscopy provide evidence that UDH is composed of various components including characteristic committed stem cell, intermediate glandular cell, glandular end cell and so on without the cells which express the myoepithelial end cells markers.

关 键 词：基底型细胞角蛋白 CK5/6 乳腺增生性病变 鉴别诊断 免疫组织化学 电镜 

分 类 号：R737.9[医药卫生—肿瘤]